HomeMy WebLinkAbout1985, 05-03 Permit App: 00005236 Addition BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner's Name (last) (first) (m) Department Only
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2 Project Address(not Mailing Address)or Road Name r -t Space Zip
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3 City/Community State Subdivision/Plat Na � � �i
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4 Assessor Parcel No. Lot Block
13544 I /D f * * * DEPARTMENT USE ONLY * * *
5 Sic Code 'Zone Act.# Zone Project No.
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6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
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7 Set BadsFn I(L)S--1 (R)S-2 I Rear Census Tract I Module No. Initials_ `1, )
*
* 16 Architect Firm Name I Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City State Phone
( )
Contact Person License No. Phone If different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City State Phone ) 62-j6
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12 Review Required Plan Check(Y/N) Other(YIN) SEPA Exempt(Y/N) Date
15 Type Work Bldg ❑ MH ❑fiew ❑ Replace ❑ Other
❑ Fire E Demo Add/Alter E Move
14 Describe Work
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10 Applicant Name Street Address
11 Zip City State Phone
( )
* *
Lender Street Address
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
DEPARTMENT APPROVALS,
This is nota Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
Fast Track
Early Start Release
Release w/cond 1 Hold 2
Environmental Health ❑ Commercial; ❑ Residential � �
W.1101 College ❑ New Construction; ❑ Bldg alteration/addition
Room 200 ❑ Additional structure;
Pl s
APPLICATION#
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; 0 lot w/d; ❑ lot size; 0 use/zone;
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
Engineers: ❑ Commercial; ❑ Residential; El Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
CI Utilities:
N.811 Jefferson
Conditions/Comments:
Other:
❑ Plan Exam
Fire Prey.
Conditions/Comments:
d.
❑
Project Representative Telephone
ca Agencies Performing Special Inspection:
O c 1.
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i 2
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3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
PLUMBING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
1 Owner's Name (Last) (First) (M) Department Use Only
Project No.
2 Project Address(Not Mailing Address) Space Zip
3 City/Community I State Subdivision/Plat Name
4 Assessor Parcel No. Lot Block
16 Contractor Firm Name Street Address
17 Zip City State Phone
18 Contact Person License No. Phone if different than above
8 Owner/Agent(if different than#1 above) ' Business Address
9 Zip City State Phone
( )
Total Number
15 Describe Work: New ❑ ; Addition/Alteration ❑ ; Replace/Repair ❑ 7
of Fixtures:
10 Applicant Name Street Address
11 Zip City State Phone
9 BarSink(s): Drinking Fountain(s): Floor Drain(s): ! Washing Machine(s):
10 Dsh Wshr(s): Garb Disp(s): Kit Sink(s): Lndry Tray(s): I Sew Eject(s):
11 Urinal(s): Wtr Closet(s): Lav(s): Shower(s): ( Tub(s): I Bidet(s):
(
Other: Type;
X12 Waste/Grease Interceptor(s):
LL
W
O 13 Sewer Y N Septic/Health No.:
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03 14 Electric Water Heater(s): , Drains-Roof:
2
Z 15 REPAIR OR ALTERATION: Drainage,Vent,Water Piping/Treatment: Y N
16 Lawn Sprinkler System(s),including backflow device on any one meter:
17 Vacuum breakers or backflow devices in excess of line 16:1-5: (Or)5+:
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state of local laws regulating construction or the performance of
construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
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